A third person in the US has tested positive for H5 bird flu in connection to an ongoing outbreak in dairy cattle, the Michigan Department of Health and Human Services said Thursday. This is the second human case reported in the state and the fourth ever in the US.

This time, in addition to some of the eye symptoms seen with previous H5N1 cases, the farmworker reported a cough and other respiratory symptoms that are more typical of human influenza infections, the health department said.

“This individual had respiratory symptoms, including a cough, congestion, sore throat and watery eyes,” Dr. Nirav Shah, the principal deputy director of the US Centers for Disease Control and Prevention, said at a briefing Thursday.